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Flat Feet and Fallen Arches

Jun 6, 2022

There are 3 different types of arches that help stabilise the foot:

  • medial longitudinal arch
  • lateral longitudinal arch
  • transverse arch

These arches may differ from one individual’s foot to another, but the one arch that differs the most in individuals is the medial longitudinal arch.

  • The medial longitudinal arch runs from the end of the heel, to the ball of the foot and down the middle of the mid foot.
  • The lateral longitudinal arch runs along the outside edge of the foot.
  • The anterior transverse arch runs from side to side, just behind the ball off the foot.

These three arches work together to help stabilise and absorb shock to adapt to differences in terrain when walking, running or exercising in gait.

There are 3 different types of foot arches; no arch (flat foot)/low arch, normal foot or arch and high foot or arch.

An individual with flat feet may have no visible arch present in the foot upon standing and may have a very low arch or no arch. This means that one or both of their feet may be flat on the ground when standing. Individuals with low arches tend to pronate, or put more weight on the inner part of their feet when they walk, this can cause problems with knee joints and knee pain. A pronated foot type with no arch or low arch is also known as a pet plants foot type. All babies have flat feet and arches form during early childhood. If arches don’t develop or they collapse in later life, this is known as fallen arches. Flat feet can cause pain and affect walking. Orthotics and stretching exercises can help prevent the pain and strengthen the muscles and ligaments of the arch and foot. However not all flat feet are symptomatic. This means that some individuals with flat feet get no pain, which means they do not need to wear orthotics or do stretching exercises, or try to change their foot type as this in itself may cause pain instead.

In normal arches or feet, this type of arch is great at distributing body weight and shock absorption in walking and physical activity such as running and exercises. However, gaining weight and other health conditions such as Charcot foot, osteoarthritis and rheumatoid arthritis can cause feet and arches to diminish or flatten with ageing. The arches need to be both sturdy and flexible to adapt to stress and a variety of surfaces.

An individual with high arch or foot and hollow arch or foot type is known as a supinated foot type. It is also known as Pes Cavus foot type. This means the inner arch is characterised through excessive arching. This foot type is only supported through the forefoot and the heel, which can lead to high-pressure points or areas. This foot type can also be varus as the the foot sinks outwards. This foot type is very unstable as it does not provide any cushioning and is very rigid.

The arches provide a spring to the step and help to distribute body weight across the feet and legs. The structure of the arches determines how a person walks. The arches need to be both sturdy and flexible to adapt to stress and a variety of surfaces.

When people have flat feet, their feet may roll to the inner side when they are standing and walking. This is known as pronation. Many people with flat feet or have no symptoms, but others will experience a variety of symptoms that generally depend on the severity of the condition.

Pronation and Supination:

Pronation and supination refers to the side-to-side motions the foot carries out as it moves. Pronation refers to an inward roll. This means if from looking at the foot down as a step is taken forward, the ankle dip toward the inside arch just after your heel strikes the ground is visible.

A certain amount of pronation is normal and in walking the foot absorbs the shock by rolling slightly inward and downward. The arch flattens briefly, with weight rolling the foot outwards and up towards the ball off the foot as the body moves forward. Then, with push off using the toes, the big toe and second toe exerts most of the ground force.

A small amount of supination is also a normal part of walking or running. When pushing forward, the foot naturally rolls toward its outside edge so it can redistribute the push-off pressure to the toes.

Low arches commonly cause over pronation and high arches commonly cause over supination. If the arch is very high, the foot may not be able to pronate enough, which may lead to push-off being done by the lesser toes.

A 1994 study found that runners with very high arches absorb foot-pounding shocks poorly compared to runners with lower arches. These biomechanical tendencies can eventually injure the ankle, ilio-tibial band, or Achilles tendons and the increased loads or stress can cause plantar fasciitis.

Symptoms:

The most common symptom of flat feet is pain in the feet. This can occur as a result of strained muscles and connecting ligaments.

Flat feet may also cause uneven distribution of body weight. This may present in shoes wearing down unevenly or more quickly than usual on one or both sides. This can lead to further injuries if symptoms are symptomatic and left untreated. If you do not have any symptoms, asymptomatic, it may not result in further injuries.

The shape of the foot and particularly the arch type can cause individuals to develop certain conditions. These conditions usually develop with ageing, or with physical activities putting repeated stress on the bones and soft tissues in the feet.

Bunions – A bunion is a bony bump on the inside of your foot near the base of the big toe. Bunions are quite common and they are particularly prevalent among older women. Although bunions can be caused by heredity factors and nonhereditary factors, such as wearing narrow or high-heeled shoes, researchers believe that low arches or flat feet increases the risks of developing bunions.

Hammer toes – Hammer toe is the common name for severe bends in the lesser toes (second, third, fourth, or fifth). It’s a condition that usually develops with ageing and can make finding suitable shoes that fit without causing discomfort or pain difficult. Research indicates both very high arches and flat feet increase the odds for developing hammer toes. Similarly, both foot shapes can make the muscles in the foot unbalanced in a way in which can change the forces going through the toes over time.

Plantar fasciitis – Plantar fasciitis is inflammation of the soft tissues that stretch from the plantar toe to your heel. It usually causes sharp pain and discomfort anywhere from the heel to the mid foot on the soles of either or both feet.

This condition has been associated with high arches and over supinated feet, as well as with low arches or flat feet.

Shin splints – If the foot posture is over pronated, there is a higher risk of developing medial tibial stress syndrome (MTSS), also known as shin splints, according to research

Shin splints cause pain that runs from the knee to the ankle on the front side of the leg, alongside the shinbone. Commonly, shin splints happen in individuals who are active in stop-and-start athletic activities such as tennis or soccer.

Ankle injuries If the foot chronically over supinates or over pronates due to the structure of the foot, the foot will be prone to ankle injuries as it may result in an ankle sprain, strain, break or tear the structures such as the muscles and tendons.

Research states with high arches, the ankle may not be as strong or well-supported as an individual with low arches.

Hip, knee, or foot pain and Chronic lower back pain – Studies have shown that the height of the arch with a pes cavus or pes planus arch can cause pain in the lower extremities in addition to the feet and the upper body. This is because when the feet move it causes a ripple effect on the movements of the upper and lower legs.

Are orthotics good for flat feet or feet with high arches? Treatments for high arches and flat feet or low arches?

Orthotics are good for flat feet when they are symptomatic. This means when the flat foot or fallen arch causes pain and discomfort. Orthotics for flat feet help alleviate pain, balance the body, and align the spine and reduce the risk of developing problems in the ankles, knees, back, and hips. The most effective type of support for flat feet is one with a supportive arch and heel stabilisation. Custom made or Bespoke orthotics are the most effective type of orthotic device for providing support for flat feet which are custom designed with arch supports, which are moulded to the contours of an individual’s foot.

However, if there is no pain in either foot, then individuals do not need to wear orthotics as wearing orthotics may cause undue pain and discomfort, if there are no symptoms from flat feet or fallen arches. No treatment is necessary for flat feet or fallen arches if they do not cause any pain and feet are asymptomatic.

Orthotics for supination or high arched foot type can help manage symptoms. A supinated foot type or cavus foot type is usually caused by a neurological disorder, or inherited from your parents. Some neurological disorders or other conditions that commonly cause high arches are Spina bifida, Cerebral palsy, Charcot-Marie-Tooth disease, Polio, Muscular dystrophy and Stroke/CVA.

It’s important to find out the cause of the high arches so a treatment plan can be put in place to treat the high arches. Cavus foot or high arches that are caused by neurological factors are more likely to worsen over time and if they are heredity or genetically linked, they are likely to stay the same unless they are managed surgically. High arches or Cavus foot type can also be managed by non-surgical methods such as orthotic devices, stretching and AFOs. Treatment is usually determined by how flexible or rigid the foot is.

Some common solutions for high arches and flat feet may include:

Orthotic devices – Orthotic devices can be custom made for an individual’s specific foot. These are worn inside the shoe to provide extra support, cushioning and stabilise the foot. This is more common in the treatment for high arches or Cavus foot type.

Corrective shoes – Certain shoes, like high-tops, may provide support, and help correct gait or walking and also relieve pain associated with high arches and flat feet.

Brace/calliper or Ankle Foot Orthosis (AFO) – The GP may recommend wearing a brace around your foot and ankle for extra support.

Surgery – Surgery may be needed in some severe cases where all conservative measures have been tried and been unsuccessful. This is common treatment in high arches and Cavus foot type.

Arch supports  in orthotic devices – Over the counter arch supports may help relieve pain caused by flat feet. The GP can refer to see a podiatrist and the podiatrist may suggest custom designed arch supports, which are moulded to the contours of the individual’s foot. However, arch supports may not always cure flat feet, but they can often reduce symptoms and pain.

Stretching exercises – Some people with flatfeet also have a shortened Achilles tendon. Exercises to stretch tendons may help resolve any pain or tendinopathies affecting the tendons and muscles.

Supportive shoes – A structurally supportive shoe can be more comfortable over sandals or shoes with no or minimal support.

Physical therapy – Flat feet may contribute to overuse injuries in some runners. A physical therapist may be able to do a video analysis of the gait and running pattern which can help to improve the running or gait form and techniques.